Honoring Physicians Who Specialize In:
OPHTHALMOLOGY Left to right: ALAN WAGNER, MD, ERIC CROUCH, MD and DENISE CHAMBLEE, MD
Quality patient care for our community. Meet some of the members of our Quality Team. They’re working to optimize the healthcare experience for our patients and referring physicians by: • • • •
Focusing on “best” Quality data Improving CAHPS survey data Improving transitions of care Coordinated care management for CHF, COPD, Diabetes and Heart Failure patients
• • •
Increasing electronic messaging with patients and electronic referrals to and from referring physicians Expanding patient access through timely and efficient communication and office visit availability Medicare Wellness Visits
Teams of physicians, residents, nurses and health professionals are working together to encourage preventive care, coordinate transitions of care and maintain overall quality of life. EVMS Medical Group’s mission of improving the healthcare of the patients that we serve means better health for Hampton Roads. Standing Left to Right: Richard Bikowski, MD Chief Quality Officer, James Lind, CEO, Lambros Viennas, MD, James Dixon, MD, Cynthia Ferguson, PA. Sitting Left to Right: Allison Gray, RN Nursing Clinical Quality Coordinator, Danya Lewis, MD
For more information, contact Dr. Richard Bikowski, EVMS Medical Group Chief Quality Officer at 757-451-6200.
Learn more at EVMSMedicalGroup.com.
Spring 2017 VOLUME V, ISSUE I I
31 How to Interview Lenders 34 Treating Chronic Pain Patients DEPARTMENTS 4 Publisher’s Letter 14 Advanced Practice Providers: Sue Doss, FNP 16 Medical Update: The Many Facets of Preventive Medicine 22 Good Deeds: Robert Lancey, MD 33 Understanding Your Patient 35 In the News 42 Welcome to the Community 45 Physician Advisory Board
FEATURES 6 Thank an Ophthalmologist
46 Awards and Accolades
8 Denise Renee Chamblee, MD 10 Eric Crouch, MD 12 Alan L. Wagner, MD
PROMOTIONAL FEATURE 25 Bon Secours: Enhancing and Expanding Cancer Care in Hampton Roads
26 A Leap Forward in Diagnosing Prostate Cancer
28 Prevention of Orthopaedic Conditions 30 Think ‘Prehabilitation,’ Not Just Rehabilitation 31 Responding to Requests for Records and/or Testimony
Taking Nominations for the Summer 2017 edition We are looking for physician leaders who specialize in
Treating the SPINE Deadline for Nomination Submissions
Treating the SPINE
Nomination forms are available on www.hrphysician.com (click nominate tab) or by emailing a request to email@example.com Spring 2017 Hampton Roads Physician | 3
WELCOME TO THE SPRING 2017 ISSUE Holly Barlow
Bobbie Fisher Editor
n April 7th, as this issue of Hampton Roads Physician was going to print, World Health Day was being observed by 194 countries across the globe. Envisioned in 1948 by the World Health Organization, World Health Day is an annual awareness initiative that draws worldwide attention to a subject of major importance to global health. Thus it seems particularly apt that the medical feature in this Spring issue deals with prevention and preventive medicine, much of which is concerned with the health of various populations. The article on page 16 addresses this vital topic from the perspectives of area specialists who have practiced at both local and international levels, and who are teaching a new generation of physicians and providers. Our cover topic is ophthalmology, and once again, we were impressed by the
A publication for
Spring 2017 Volume V, Issue II
Recognizing the achievements of the local medical community Publisher: Holly Barlow Editor: Bobbie Fisher Cover photos by Abejon Photography Physician Advisory Board (see page 45)
Published by Publishing, LLC Emeritus and Voting Board Alfred Abuhamad, MD O.T. Adcock, Jr., RPh, MD Jon M. Adleberg, MD
4 | www.hrphysician.com
Our secondary feature for the Summer issue is Geriatrics and Palliative Care, surely a timely topic at any time of the year. If you’re a physician who’d like to contribute to that article, please let us hear from you. Finally, a word of thanks to the advertisers whose support for this magazine makes it possible for us to publish, and to our readers, whose continuing interest is our raison d’etre. Blessings and health. Holly Barlow, Publisher: 757.237.1106 firstname.lastname@example.org Bobbie Fisher, Editor: 757.773.7550 email@example.com Fax: 757.222.1345 hrphysician.com
and about the local medical community
Magazine Layout and Design Desert Moon Graphics
number and caliber of nominations we received honoring local specialists. Our Physician Advisory Board reviewed and weighed these nominations thoughtfully, and chose Dr. Denise Chamblee, Dr. Eric Crouch and Dr. Alan Wagner to be recognized. Their profiles reflect innovative approaches to their specialties and dedication to their patients. Our Summer issue will focus on those specialists who treat back pain, and more specifically, conditions of the spine. As always, we’re looking for leaders in the field – practitioners who have spearheaded groundbreaking techniques, surgeries and innovations that have changed the lives of patients who have suffered, sometimes for years, from conditions that impede motion, movement and quality of life. Please see the bottom of page 3 for nomination information.
John W. Aldridge, MD, FAAOS Anthony M. Bevilacqua, DO Silvina M. Bocca, MD, PhD, HCLD Mary A Burns, MD, FACOG, FPMRS Jeffrey R. Carlson, MD Kevaghn P. Fair, DO Bryan Fox, MD Margaret Gaglione, MD, FACP Emmeline C. Gasink MD, FAAFP, CMD Mark W. McFarland, D.O. Jennifer Miles-Thomas, MD, FPM-RS Jerry L. Nadler, MD, FAHA, MACP, FACE Paa-Kofi Obeng, DO Jennifer F. Pagador, MD Richard G. Rento II, MD Michael M Romash MD Michael Schwartz MD John M. Shutack, MD I. Phillip Snider, DO Deepak Talreja, MD, FACC, FSCAI Jyoti Upadhyay, MD, FAAP, FACS Christopher J. Walshe, MD, FACOG, FACS, FPMRS Elizabeth Yeu, MD
Contact Information 757-237-1106 firstname.lastname@example.org Hampton Roads Physician is published by DocDirect Publishing, LLC, 1263 Manchester Ave., Norfolk, VA 23508 Phone: 757-237-1106. This publication may not be reproduced in part or in whole without the express written permission of DocDirect Publishing, LLC. Published four times a year, Hampton Roads Physician provides a wide variety of the most current, accurate and useful information busy doctors and health care providers want and need. Cover stories concentrate on one branch of medicine, featuring profiles of practitioners in that specialty. Featured physicians are chosen by the advisory board through a nomination process involving fellow physicians and public relations directors from local hospitals and practices. Although every precaution is taken to ensure accuracy of published materials, DocDirect Publishing, LLC cannot be held responsible for opinions expressed or facts supplied by its authors. Visit Us Online
If you can read this, thank an ophthalmologist. By Bobbie Fisher
n his opening address to the Winter Session of the Royal Victoria Hospital, 1945-46, entitled A Synopsis of the History of Ophthalmology, James R. Wheeler, MB, FRCSED, DOMS, wrote: “The uncertainties of unrecorded history make it impossible to say where the dawn of civilisation began, but the earliest mention of any medical matter is found in an ancient work on law. About 2250 BC, Hammurabi, a king of Babylon, Assyria, promulgated a collection of laws.” As every history student learns, one of the most famous and enduring of these Hammurabic codes is an eye for an eye, sometimes referred to as the law of retaliation. But it turns out that Hammurabi had more in mind than retaliation – in fact, as Dr. Wheeler wrote, “A considerable number of sections of these laws relate to ophthalmology…” and specifically to compensation for those who successfully performed eye surgery, and recompense from those who did not. In the case of payment, Hammurabi declared as follows: 215. If a physician make a large incision with an operating knife and cure it, or if he open a tumor (over the eye) with an operating knife, and saves the eye, he shall receive ten shekels in money.
216. If the patient be a freed man, the physician receives five shekels.
217. If the patient be the slave of some one, his owner shall give the physician two shekels. Not exactly equitable by 21st century standards, but obviously, in 2250 BC, not all eyes were considered equal. Hammurabi was far less generous to eye doctors when they failed: 218. If a physician make a large incision with the operating knife, and kill him, or open a tumor with the operating knife, and cut out the eye, his hands shall be cut off. 6 | www.hrphysician.com
The Code was less harsh if the patient was a slave: 219. If a physician make a large incision in the slave of a freed man, and kill him, he shall replace the slave with another slave.
220. If the physician open a tumor with the operating knife, and merely put out the slave’s eye, he shall pay half his value. Hammurabi may have been looking to his own house; it’s believed by many that he suffered from cataracts, and may have been a candidate for the surgery. Whether he actually underwent surgery, and what the nature of that might have consisted of, is lost to history. The first technique to treat cataracts wasn’t documented until the 6th century BC. Couching, or the practice of using a sharp instrument to push the cloudy lens to the bottom of the eye, was described by the Hindu surgeon Sushruta, and was later adopted by the Greeks and Romans, as well as the Egyptians, Arabs and Europeans. It was the only method of cataract treatment until the 19th century. Luckily for physicians and patients alike, eye surgeries – whether for cataracts or other conditions – have become far less dangerous over the course of millennia, while technical and medical advances in treating eye diseases and correcting eyesight have made clarity of vision accessible to nearly everyone. Despite these dramatic advances, the National Eye Institute, an arm of the National Institutes of Health, estimates that between 2010 and 2050, the number of people affected by the most common eye diseases will double. Thus the contributions of ophthalmologists like our featured specialists and the many across Hampton Roads who were nominated, are more vital than ever – and another reason this community is so fortunate.
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DENISE RENEE CHAMBLEE, MD Hampton Roads Eye Associates, a division of Riverside Health System
ven before she went to college, Denise Chamblee was fascinated by eyes – although it didn’t occur to her to devote her career to caring for them until much later. She didn’t even decide to go to medical school until her second year at the University of Texas at Austin. She earned her Bachelor’s in Liberal Arts, but liked science as well, excelling in those classes. Her “aha!” moment came when she realized she wanted a profession that would allow her to work with people, doing something to help them. She moved to San Antonio to study medicine at the University of Texas Health Science, and kept an open mind about specialties, knowing only that she wanted to do some surgery, but not exclusively. A chance pairing with an advisor led her to pursue her interest in eyes. “The school tried to assign advisors we’d have 8 | www.hrphysician.com
something in common with,” Dr. Chamblee says. “Jean Holt, like me, was from Missouri. She was also an ophthalmologist. She was a great influence, introducing me to aspects of ophthalmology that cemented my fascination. She showed me I could have a more normal life in ophthalmology than in some other specialties.” Dr. Chamblee completed her internship and residency in ophthalmology at the University of Oklahoma, followed by a fellowship in pediatric ophthalmology at Children’s National Medical Center in Washington, DC. The appeal of working with children was irresistible: “There’s something innately beautiful about days filled with children. Their laughter, their hugs, and their innocence keep me smiling, refreshed and focused on what’s really important.”
When they’re seated in front of her, the most important thing is being able to communicate with these young children. “It’s definitely a skill to communicate effectively with kids who can’t describe what they’re seeing,” Dr. Chamblee explains. “That’s one of the challenges of pediatric ophthalmology that I still love: getting good eye exams, even on patients as young as two, who tend to squirm around.” The only pediatric ophthalmologist in her practice, Dr. Chamblee has filled her office with toys and games that keep her patients engaged, and also allow her to determine how they’re seeing. While the field of pediatric ophthalmology is still relatively young, technology has provided her additional tools. “With my technicians (who she proudly notes have been with her for twenty-plus years), I can essentially measure the power of their glasses without them telling us a thing,” she notes, explaining: “A retinoscope projects a beam of light into the eye. When the light is moved vertically and horizontally across the eye, we observe the movement of the reflected light from the back of the eye. We then introduce lenses in front of the eye and as the power of the lenses changes, there’s a corresponding change in the direction and pattern of the reflection. We change the lenses until reaching a power that indicates the patient’s refractive error.” Because early diagnosis and intervention are so critical to preventing blindness, Dr. Chamblee is excited about a recent innovation that is bringing younger patients to her much sooner. “Photoscreening is being done by school nurses, pediatricians and visionfocused groups,” she says. “It uses a special-purpose camera to determine whether a child has risk factors and should be referred to a specialist. By detecting special light reflexes from each eye, images are produced that can help identify refractive errors and ocular misalignments, which place children at risk for amblyopia. We can then dilate their eyes and assess the need for corrective lenses or surgery. It’s particularly useful with pre- or nonverbal children.” And because there’s a critical period in visual development after which it may be too late to intervene, photoscreening is – or should be – a routine part of every well-child visit. “It’s really making a difference,” Dr. Chamblee says, “particularly for kids whose eyes aren’t misaligned and don’t signal parents that something’s awry. I’m seeing kids at an earlier age and identifying problems I’d never see at that age just five years ago.” Another promising development is in retinopathy of prematurity, a disease that causes babies born before term to lose their sight. “We’ve always done a laser procedure if they get to that point where blindness is likely,” she says, “but there’s a treatment being used now in certain cases – injection of a vascular endothelial growth factor inhibitor. The research is concentrating on dosage, timing, and effect on other organs.” The most common cancer affecting children’s eyes is retinoblastoma, and while Dr. Chamblee sees it only once or twice a year, there’s good news on that front as well: “These patients used to lose an eye, but today, if we can diagnose and begin to treat it early, even if there are tumors in both eyes, we can usually save both.” Like many of her colleagues, Dr. Chamblee worries about the increasing amount of time physicians are required to spend on administrative tasks that have no relation to hands-on patient care. “Especially dealing with infants and children, and with their anxious parents, I want to focus all my attention on each little child in front of me,” she says. When she’s not caring for their eyes, Dr. Chamblee advocates for children. She devotes her few discretionary hours to service on the Board of Achievable Dream School and to mentoring through the New Horizons Governor’s School for Science and Technology – no doubt hoping to inspire students as Dr. Holt once inspired her. Spring 2017 Hampton Roads Physician | 9
ERIC CROUCH, MD
Chief of Ophthalmology, Children’s Hospital of The King’s Daughters Virginia Pediatric Eye Center
Photo by: Abejon Photography
r. Eric Crouch developed a strong interest in medicine early in life. As a 7th grader at Norfolk Academy, one of his teachers asked his class to write a statement predicting what they would be doing in 10-15 years. At graduation, the teacher gave their answers back to them. “Everything I had written on that list was exactly what I ended up doing,” he says. After graduating from the University of Richmond, Eric returned to Norfolk to earn his medical degree from Eastern Virginia Medical School. He was already familiar with the school, having previously participated in research in the Department of Pharmacology as an undergrad. Although he considered other specialties, he ultimately chose the same field of medicine and surgery as his father, Earl Crouch, Jr., MD. The elder Dr. Crouch is a well-respected ophthalmologist who helped establish the Department of Ophthalmology at EVMS and served as Chairman of Ophthalmology and Residency Program Director for more than 30 years. Together they practice at Virginia Pediatric Eye Center with Dr. Eric Hein and Dr. Stacy Martinson. Dr. Crouch also credits Dr. Thomas Wilson at the Geisinger Medical Center in Pennsylvania, and his attendings at the prestigious Children’s National Medical Center in Washington, D.C., where he completed a fellowship in pediatric ophthalmology and adult strabismus. He was one of the last fellows of Dr. Marshall Parks, who had also trained Dr. Earl Crouch, Jr. in fellowship. In addition to maintaining a robust clinical and surgery practice, Dr. Crouch heads up the curriculum for the pediatric ophthalmology section for EVMS residents. He has mentored dozens of medical students and ophthalmology residents, and has proudly seen his trainees go on to the Mayo Clinic, Duke Medical Center, Boston Children’s, and Yale. He has been involved in more than 80 scientific publications and presentations, written 12 book chapters, and edited three textbooks. From his earliest days of practice, clinical research has been a significant focus of Dr. Crouch’s career. He has played a leadership role at both the local and national levels and has served as an investigator in various multidisciplinary studies at CHKD and EVMS. He has also been involved in more than 20 studies for the Pediatric Eye Disease Investigator Group (PEDIG), a collaborative network dedicated to facilitating multicenter clinical research in strabismus, amblyopia, and other eye disorders that affect children. This network, formed in 1997, is funded by the National Eye Institute, part of the National Institutes of Health, and focuses on advancing the management of pediatric disease conditions. During the past decade, Dr. Crouch has served on PEDIG’s Executive Committee, Operations Committee, Steering Committees, and Writing Committees. He also served as Vice-Chair of the network for two years, with responsibilities to more than 150 active clinical sites throughout the US, UK, and Canada. He has 10 | www.hrphysician.com
In addition, Dr. Crouch is excited about the role large-scale clinical registries are playing in data mining about conditions like strabismus, pediatric cataracts, and pediatric optic neuritis. “The hope from these registries is that the data we collect will allow us to identify different associations, or linkages between treatments and improve outcomes,” he says. “Large-scale registries create an opportunity to design better studies to address uncommon conditions. It’s a long term situation with five and ten year outcomes. As with any study, we try to retain as many patients longitudinally to ensure we have the most reliable data analysis possible.” These registries are important in multiple situations, particularly cases like pediatric optic neuritis, a relatively infrequent condition in children, because a single pediatric ophthalmologist may see only one or two patients in a year. Across the country, there might be hundreds of cases that could yield significant data. “That’s the power of a registry,” says Dr. Crouch, who is currently involved in several such studies. Dr Crouch’s passion for research isn’t limited to pediatric ophthalmologic conditions. As PEDIG protocol chair for an ongoing Study of Adult Strabismus prospective study, he will continue to oversee data collection through the end of this year on three of the most common non-paretic strabismus conditions in adults: convergence insufficiency, divergence insufficiency, and small angle hypertropia.
Photo by: Abejon Photography
reached the highest level ever achieved in the EVMS Department of Ophthalmology for serving as a clinical research administrator for an entire multi-center network involved in randomized clinical trials and epidemiologic studies. He has been active on various multidisciplinary research projects and clinical endeavors with the CHKD Departments of NICU, Neurosurgery, Neurology, Genetics, Endocrinology, and Craniofacial Surgery. He takes great satisfaction in being able to assist the departments of Plastic Surgery, Neurosurgery, and Craniofacial Surgery in complex craniofacial disorders and managing the associated ophthalmologic disease processes. Dr. Crouch has a particular interest in the development of better treatments for amblyopia, strabismus, and visual rehabilitation. Current research is exploring newer binocular treatments beyond standard monocular treatments. “There’s ongoing research where we don’t necessarily completely patch the good eye,” Dr. Crouch explains, “but rather we’re creating a situation through special glasses and computer software to modify contrast fields, monocular cues, and impacting ocular fusion development. These newer mechanisms may provide better physiologic outcomes. We’re also investigating the use of specially designed video games that attempt to improve both eyes simultaneously. As the child improves, therapeutic compliance also improves.”
Spring 2017 Hampton Roads Physician | 11
ALAN L. WAGNER MACULA & RETINA CENTER
Photo by: Abejon Photography
s a youngster growing up in Omaha, Nebraska, it was instilled into Alan Wagner that as a member of a community, he had a responsibility to it. “It’s called tikkun olam,” he says. “It’s one of the guiding principles of Judaism: that we have a responsibility to repair the world, to pursue justice through social action.” Both of his parents were actively involved in their community, secular and non-, his mother serving as the voice of the League of Women Voters and ultimately being elected Vice Mayor of Omaha. Community service wasn’t the only lesson he learned from his parents: accompanying his mother to her frequent guest spots on KFAB-AM, he absorbed the skill of radio broadcasting; and from his father, a World War II pilot who also photographed the war, he discovered the art of the camera and the darkroom. By the time he was in high school, he was hosting a program on the local public radio station, and taking photographs and providing prints to local churches and synagogues. As a student, he also enjoyed music, jewelry making and a number of creative arts. So when it came time to choose a career path, Alan Wagner had a lot of options. It was a friendly neighbor in Omaha who led him to medicine. “His name was Dr. Abe Feldman, and he was very well respected in Omaha,” Dr. Wagner says. “He embodied caring for others with honesty, intellect, and humor.” After attending Northwestern, Dr. Wagner went to Vanderbilt for his medical degree, and stayed to complete a general surgery internship. Despite an early interest in cardiothoracic surgery, he was drawn to the intricacies of the human eye, intrigued by the burgeoning technology becoming available. “It was the golden age with the use of microscopes,” he says, “and the huge impact that was having. It was the combination of the delicacy of the eye, the nuance – and having to really understand the physics and engineering of the growing microsurgery. It was irresistible.” He took the Lancaster Course in Ophthalmology, the oldest and largest educational course in the world, and completed a residency in ophthalmology at EVMS. He 12 | www.hrphysician.com
WAGNER, MD later completed an AFIP course in ocular pathology. He did a stint as Chief Resident in Ophthalmology at EVMS, and in 1986, began a year as a Dyson Fellow in Retinal and Vitreous Disease and Ophthalmic Trauma at Cornell University in New York. In 1987, Dr. Wagner returned to Virginia to establish the practice he maintains today: Wagner Macula & Retina Center, which has now expanded to nine offices throughout Hampton Roads. From these offices, Dr. Wagner and his partner, Dr. Kapil Kapoor, treat a variety of complex eye conditions – including diabetic eye disease, macular degeneration, ocular tumors, uveitis, macular pucker and holes, retinal detachment, and retinal vascular disease. Since the earliest years of his practice, Dr. Wagner has been committed to research. The practice is currently involved in at least a dozen randomized clinical trials; in fact, so committed is he to the research component that the practice’s new Norfolk location is designed around a research center. Research is critical, he says, “because we’re learning how to halt the conditions that make people go blind. We’re involved with research on diabetes and auto immune disorders – the number one and number two causes of blindness; a close third is macular degeneration. We have active projects in all three areas.” Dr. Wagner is adamant that blindness can be prevented; it takes education and access to services – and this is a large part of why he has chosen to open offices in two of the poorest counties in the Commonwealth. “It’s part of the tikkun olam mode of caring for the whole community,” he says. “We kept seeing people coming to us from these areas, nearly or completely blind. It was horrible. On the Eastern Shore alone, there is about a 22 percent underinsured – and underserved – population rate. It’s just about getting care to people, how they want to get it, and personalizing it, while doing it inexpensively, so there’s enough money to go around for everybody.” Dr. Wagner is excited about the role prevention is starting to play in eye care. “And we’re learning so much more about genetics, so we’re able to do true, personalized health care, allowing patients to better own their condition, while understanding their options and their odds. And with research, we’re understanding more about the molecular and metabolic pathways.” The results of such knowledge, he says, are evident in care: “We used to essentially take a bulldozer to transplant a blade of grass. I’m doing less than a hundredth of the lasers
I did five years ago, because we have medicines to do the same thing. We’re doing less of the invasive, ablative tissue-altering procedures because of medicines that are being developed.” What he sees in the not too distant future is the increasing importance of remote imaging, along with fewer surgeries being performed. And he thinks, “We’re going to have greater access to gene therapy, combined with personalized medicine, that will allow us to offer long term therapies that will prevent or even reverse some problems.” He calls this new golden era ‘the age of injections.’ “We have many people coming in every month for an injection to save their sight, kind of like dialysis for the eye. It works, and it’s very safe. I’m excited that soon we’ll have better and more durable ways to treat specialized eye problems. Through our research, we’re already starting to see that.”
Photo by: Abejon Photography
Spring 2017 Hampton Roads Physician | 13
A D VA N C E D P R A C T I C E PROVIDERS
It is an honor to highlight local Nurse Practitioners and Physician Assistants as they are increasingly invaluable members of the healthcare industry. We congratulate Sue Doss.
SUE WHITEHURST DOSS, FNP EVMS Internal Medicine
NP isn’t the only designation that accompanies Sue Doss’ name: her full title includes RNC, MSN and ADM as well. That wasn’t part of her original plan: when she decided to go into nursing, she didn’t think she’d go beyond getting her initial degree, being the first in her family to graduate from college. But while she was enrolled in the Nursing Program at Old Dominion University, she realized her love of science and medicine, and her innate desire to help people, were inspiring her to do more. She practiced for seven years after graduation, both at Sentara Norfolk General Hospital and in public health settings in Norfolk and Chesapeake. “Public health is what I really loved,” Doss says, “meeting the needs of underserved populations.”
Her work in public health allowed for more autonomy, Doss explains, where she could work one-on-one with patients and coach them to better health. “That’s when I decided I wanted to pursue my Nurse Practitioner degree”. She enrolled in Old Dominion’s program and earned her NP degree in 1995. She initially wanted to work in women’s health, with emphasis on caring for women with infectious diseases like HIV, but when a position wasn’t immediately available, she started working in family practice. “I loved it right away,” Doss says. And now, as a member of the EVMS Internal Medicine team, she feels she has come full circle, working with infectious disease patients, as well as diabetics, which allows her to put her Advanced Diabetes Management certification to use. “We see the gamut – diabetes, heart failure, hypertension, arthritis, kidney disease, pulmonary disease – everything that can affect adults with chronic and acute medical needs.” Doss enjoys the variety, and especially credits the faculty and physicians at EVMS, who can seamlessly collaborate for the benefit of patients. “We’re lucky to have such brilliant doctors here in the community, who are excellent resources,” she says, “and because of the system’s electronic medical records system, we’re able to provide continuity of care across all departments, for patients with multiple medical issues.
That allows us to get to know these patients and their families, and it is really rewarding when you know they trust you.” As a Nurse Practitioner, Doss is fascinated by the expanding opportunities her profession provides to educate patients about their health, and she’s adamant about the importance of prevention. “I feel more and more that a large part of my role as an NP is to help people start doing what they need to do so they don’t get sick in the first place,” she says. “It’s inspiring when you see a patient who’s lost 12 pounds in less than a month, simply because she gave up soft drinks and starting walking.” She acknowledges it can be difficult: “Change – no matter whether it’s losing weight, quitting smoking, exercising – is hard. But it’s amazing what people can do. And as healthcare providers, we have to always be ready to introduce the subject, and to assure them that we’re here to help them along the way.” Doss may not have intended to acquire so many letters when she first decided to become a nurse, but today, she says, “I believe we all have a path, and we don’t always know where the path will take us. But I think we end up where we’re supposed to be. I know that’s true for me at EVMS. It’s just what I envisioned years ago: I’m helping patients be healthier, and I’m helping them when they need medical care.”
If you work with or know a Physician Assistant or Nurse Practitioner you’d like us to consider, please visit our website – www.hrphysician.com – or call our editor, Bobbie Fisher, at 757.773.7550. 14 | www.hrphysician.com
To make an appointment please visit: riversideonline.com/neurology Spring 2017 Hampton Roads Physician | 15
MEDICAL U P D A T E
THE MANY FACETS OF PREVENTIVE MEDICINE
January 19, 2017 article on the website of the American College of Preventive Medicine ran with the headline, Preventive Medicine’s Identity Crisis. Authors Dr. Boris Lushniak and Dr. Paul Jung posed this question: “What is preventive medicine? Specifically, what is the specialty of preventive medicine, and how should it best be described?” The physicians explained: “The specialty of preventive medicine is poorly understood, not only by the medical profession and the general public, but even among some of its practitioners. Currently, there is no unifying, vernacular explanation of the specialty of preventive medicine, to its detriment.” The confusion isn’t so difficult to understand; within the term ‘preventive medicine’ care are a number of specialties and subspecialties.
From the American Board of Preventive Medicine: • Preventive Medicine is the specialty of medical practice that focuses on the health of individuals, communities, and defined populations. Its goal is to protect, promote, and maintain health and well-being and to prevent disease, disability, and death. Preventive medicine has three specialty 16 | www.hrphysician.com
…it’s small wonder that preventive medicine might be suffering an identity crisis. With so many individuals, populations and communities falling under one or more … categories, the lines between and among specialties can be blurred.
areas with common core knowledge, skills, and competencies that emphasize different populations, environments, or practice settings: aerospace medicine, occupational medicine, and public health and general preventive medicine. • Public health and general preventive medicine focuses on promoting health, preventing disease, and managing the health of communities and defined populations. These practitioners combine population-based public health skills with knowledge of primary, secondary, and tertiary prevention-oriented clinical practice in a wide variety of settings. • Occupational medicine focuses on the health of workers, including the ability to perform work; the physical, chemical, biological, and social environments of the workplace; and the health outcomes of environmental exposures. • Aerospace medicine focuses on the clinical care, research, and operational support of the health, safety, and performance of crewmembers and passengers of air and space vehicles, together with the support personnel who assist operation of such vehicles.
Additionally, the ABPM has traditionally identified three subspecialties within preventive medicine: Clinical Informatics, Medical Toxicology and Undersea/ Hyperbaric Medicine. In March 2016, the American Board of Medical Specialties announced the recognition of Addiction Medicine as a new subspecialty under the APBM. So it’s small wonder that preventive medicine might be suffering an identity crisis. With so many individuals, populations and communities falling under one or more of these categories, the lines between and among specialties can be blurred. On a recent Monday morning on the campus of Eastern Virginia Medical School, Dr. Christine Matson, professor and chair of the Department of Family and Community Medicine, was talking to a class of third-year medical students about prevention. The class was reviewing a series of scenarios previously given to them, in which they were asked to identify preventions, sources they relied on, principles of preventive medicine, and whether the scenario involved primary, secondary or tertiary prevention. One case involved a 9-month old infant. The responding student addressed the issue of injuries, and listed preventions that included installing rear-facing car seats,
Dr. Christine Matson
installing smoke detectors in the home, and importantly, ensuring babies sleep on their back, with all objects removed from the bed. Her source was the Academy of Family Physicians. The scenario involved primary preventive medicine. While the students considered several other scenarios, Dr. Matson emphasized the tendency of some people to think that the reason others get sick (other than genetics), is because they aren’t doing the right things, or they don’t know the right things. “Educational deficits is certainly part of it,” Dr. Matson told them, “and having a good education and being health literate correlates well with improved health for the future – but education isn’t enough. The fact is that too many of Spring 2017 Hampton Roads Physician | 17
our dollars go to treatment rather than to prevention.” Dr. Michael Levine, a preventive medicine specialist in Williamsburg, Virginia, agrees. “The goal of primary prevention is to prevent new disease by reducing risk factors, or to prevent the onset of preventable conditions. Not smoking significantly reduces the risk of developing lung cancer. Eating well avoids diabetes. Fluoride in the water prevents caries. The problem is, nobody wants to pay for prevention. It’s hard to sell and very easy to defund.” In secondary prevention, Dr. Levine continues, “disease is at its incipient stage, when it’s possible to walk it back completely, or at the least, make the outcome better. Losing excess weight can slow or stop diabetes. In the case of noiseinduced hearing loss, for example, we may not be able to reverse it, but we can prevent further loss.” Screening procedures are often the first step in secondary prevention. Tertiary prevention’s goal is to reduce the damage caused by symptomatic
Dr. Michael Levine
18 | www.hrphysician.com
disease, and to prevent further pain and damage, halt progression and complications from disease, and to the extent possible, restore the health of patients affected by disease. Still, “It’s not surprising that so many of
our health care dollars go to treatment rather than to prevention,” Dr. Levine says, “despite the fact that primary prevention would probably save a lot more money than any curative activity.” Both Dr. Shannon Blackmer, LCDR, a preventive medicine physician with the US Navy and Marine Corps Public Health Center in Portsmouth, and Dr. Donald Hastings, a primary care physician with Bon Secours Patient Choice Oceana in Virginia Beach, have seen first hand what happens in the absence of strong preventive medicine. Dr. Blackmer assists a team with planning Global Health Engagements in Central and South America. In the summer of 2015, she deployed in support of Southern Partnership Station, an annual series of US Navy
deployments focused on subject matter expert exchanges with partner nation militaries and civilian medical personnel in Central and South America and the Caribbean. She continues to plan engagements for this mission. US military teams work with partner nation forces during naval-focused training exercises, military-to-military engagements and community relations projects in an effort to enhance partnerships with regional maritime activities and improve the operational readiness of participants. “We’re trying to build our partner countries’ capacity to improve their health, to teach them things they can teach others in their country to improve their overall health structure.” She describes the conditions she found: “We went to a very small clinic and met the local medical staff. They were in the middle of a vaccination drive. I asked how they were able to keep track of the children who had been vaccinated. One of the nurses pulled out a very large, very old book, and showed me page after page on which the children’s names had been handwritten. This was their only record.” Dr. Hastings has seen similar circumstances. “I’ve done a lot of overseas work, in Africa, where our hospital was filled with patients who had preventable illnesses – like diarrheal illnesses caused by unclear water,” he says. “We saw tuberculosis, malaria, meningitis – the same patients with the same conditions over and over, conditions that could have been prevented through simple changes like adding bed nets and spraying.” Dr. Hastings spent time in China, as well, which he says was doing better
Dr. Shannon Blackmer, LCDR
than Africa, but still lagged far behind the US. “We were in an area with a great deal of HIV infection,” he says, so we did public health training as well as treating patients.” In daily practice as primary care physicians, Dr. Hastings says, “We’re
at the forefront of taking care of patients, and preventive medicine is the key. A big part of our job is being sure that patients are up to date on preventive screenings.” For a primary or family care practitioner, it can be frustrating, Dr. Hastings says, “because every specialty has its own academy with its own guidelines, and they can sometimes conflict with others.” Dr. O. T. Adcock, an administrator and family medicine physician with the Riverside Health System, agrees: “Many different societies publish recommendations, and they’re often in agreement or very similar. But occasionally there’s disagreement – for instance, at what age should women start getting mammograms and how often? It’s the same with the PSA test – some guidelines say stop doing at 75, but if I have a patient who’s that age or older, who’s otherwise very healthy
and likely to live a decade or more longer, I’ll certainly order the test. A lot depends on the individual patient. That’s when we prove that medicine is as much an art as a science.” Both Dr. Adcock and Dr. Hastings rely heavily on the guidelines set forth
Dr. Donald Hastings
Spring 2017 Hampton Roads Physician | 19
Dr. O. T. Adcock
by the United States Public Health Service Task Force. Establishing the guidelines under which primary care physicians operate is the bailiwick of preventive medicine specialists like Dr. Levine,
20 | www.hrphysician.com
whose practice takes him to several locations each week: a federal agency one day where he’s the onsite occupational medicine doctor, or a clinic in Williamsburg where he evaluates employees to determine whether they can safely perform their assigned jobs. He performs medical qualification exams, commonly done on employees with safety sensitive jobs: police officers, firefighters. Additionally, he looks at workplace settings of employees with specific medical conditions, and helps find ergonomic solutions that make that workplace work for them. “We really focus on function,” Dr. Levine explains. “I can clear a bus driver in his eighties for a short duration, while denying clearance to a 40-year old with a disqualifying condition. If we’re doing our job correctly, we’re setting the
stage for workers to remain on the job safely, without injury, for as long as they want to be there.” Workers can perform their jobs in the air or under water, as well as
Dr. Lambert Parker
on the ground. As a former flight surgeon, Dr. Blackmer ensured that pilots were safe to fly, without injury or illness, and not taking any form of medication that could interfere with their ability to be in the cockpit. When incidents did occur, she participated in accident investigations as well.
A New Definition for the 21st Century Dr. Lambert Parker, who maintains a private practice in Virginia Beach and also serves as Medical Director of Integrative Longevity Institute of Virginia, takes an ecological approach to preventive medicine, and genetics plays a large role. He is a proponent of the Human Biome Project, which was established in 2008. “The HBP is the collection of all of the microorganisms living in association with the human body,” Dr. Parker says, “and because of our newfound and ever expanding knowledge of genomics and microgenomics, new cognitive tools are letting us see the world and biology in a different way. “We can’t continue to prevent problems by giving a shot. People are getting more obese every day, while there’s a gym on every corner,” Dr. Parker says. “We’ve beaten the things that were catastrophes for our forefathers – malaria, typhoid, leprosy – but human beings aren’t healthier and more productive. We’re living longer, but sicker. We have to address these problems from a 21st century perspective.” Dr. Matson agrees. “We need to think about primary prevention and the ways we’ve designed our environment that have greatly increased the incidence of chronic diseases in our population. We still don’t have all the information we
need, and all you have to do is open the Internet to see all the products being advertised as tonics and curealls, to know that there’s a huge number of dollars being spent on pills, because people are looking for an easy way to be healthy.” “We’re making some progress,” says Dr. Adcock. “But people are still drinking sugary drinks, still smoking,
still not exercising. These are the basics.” Changing those three things might well be the health care revolution the country needs.
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Throughout Hampton Roads, there are physicians who regularly volunteer their time, knowledge, training and experience to individuals and organizations in this community, in the nation and throughout the world. They do so quietly, without fanfare, and often without reward or recognition of any kind. Hampton Roads Physician is pleased to acknowledge these physicians by sharing their good deeds with our readers.
Robert Lancey, MD
Heart Health Academy at Bon Secours
hen cardiothoracic surgeon Dr. Robert Lancey joined Bon Secours Heart & Vascular Institute in 2013, he brought with him an innovative program that had its roots two decades earlier at the University of Massachusetts Medical Center. “I was teaching off-pump cardiac surgery to classrooms of visiting surgeons, operating with a camera to demonstrate how to perform the operation.” Around that time, the University was routinely inviting high school students to tour the medical facilities, and it was suggested that Dr. Lancey allow them to observe him operating as well. “The students were fascinated,” he says, “and they liked being able to ask questions while we were operating. Someone inevitably asked why the patient needed the surgery, and as I
explained that heart disease is caused by lifestyle choices – smoking, poor diets, and lack of exercise – it struck me what a great opportunity I had to show, rather than tell them, the results of those choices.” This led him to subsequently set up an educational class for area seventh graders while at Bassett Medical Center in Cooperstown, NY, and over the first eight years of the program, over 10,000 students participated. “The original program was about teaching them not to smoke, to exercise, and to eat healthy,” he says, “but it changed and evolved as I saw what worked and how the students responded.” When he began practicing at Maryview Medical Center, he adapted the program for Hampton Roads – where more than 30 percent of adults and 15 percent of children are obese – and renamed it the Heart Health Academy at Bon Secours – HHA@BS. The HHA@BS is a three-hour program featuring interactive demonstrations and discussions, videos of open-heart surgery and of lungs damaged by smoking, taken right from the operating room. “We know heart disease begins at an early age,” Dr. Lancey says, “and many kids are offered their first cigarette at 13. We’ve targeted the program to the age when they’re beginning to make lifestyle choices. We start out talking about healthy decision making: seventh graders are smart enough to know what’s right and what’s wrong, so we talk to them about how fast food and tobacco
marketing tries to influence their decisions. We also hook them up to a heart monitor and have them run around the room, so they can see what exercise does for their heart.” No cute cartoon drawings or animated clips for these students: they’re seeing an open chest, a beating heart, and smoke damaged lungs. They’re seeing buildups of fat and cholesterol blocking blood vessels. They’re seeing surgeons opening up these vessels, stabilizing the heart. “We hit them pretty hard,” Dr. Lancey says of the students. “We treat them like adults. We don’t just give them facts; we show them reality. And we impress on them that they’re the ones who are in control of their health, that they can make their own decisions, but need to make the right ones.” In its first year, seven area schools participated in HHA@BS; this year Dr. Lancey anticipates the number will grow to twelve. The service is provided to the schools free of charge. In addition to teaching seventh graders, Dr. Lancey has also devised similar programs based on the age of the students – from second grade to high school. He also envisions a robust HHA@ BS online presence, providing a different heart-health related topic each week. The site could allow students to log in, record their exercise, and even more fully participate. “I give the students a chance to see what it takes to get on my operating table,” Dr. Lancey says, “so that hopefully they never get there.”
If you know physicians who are performing good deeds – great or small – who you would like to see highlighted in this publication, please submit information on our website – www.hrphysician.com – or call our editor, Bobbie Fisher, at 757.773.7550. 22 | www.hrphysician.com
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ENHANCING AND EXPANDING CANCER CARE IN HAMPTON ROADS … the Bon Secours Cancer Institute at Harbour View
n 2014, the Bon Secours Cancer Institute at DePaul opened Francis Hospital and Medical Center in Hartford, Connecticut and its doors, a $20 million investment heralded as offering “a his fellowship in gynecologic oncology at Massachusetts General comprehensive continuum of interdisciplinary care and Hospital in Boston, MA. treatment to cancer patients in Hampton Roads.” The Institute, He previously served as an instructor in obstetrics, gynecology which includes a team of radiation oncologists, surgeons and and reproductive biology at Harvard Medical School. He is other cancer specialists, was the first step in Bon Secours’ strategic a member of the American Congress of Obstetricians and plan to address the Gynecologists, American Association of Gynecologic high incidence of Laparoscopists and the Society of Gynecologic Oncology. cancer and mortality Dr. McCann practices gynecologic oncology and performs rates throughout major gynecologic surgeries, focusing on medical and surgical Southeastern Virginia. management of patients with ovarian, endometrial and cervical It was a highly cancer with an emphasis on minimally invasive techniques, ambitious and successful including laparoscopy endeavor, but Bon and robotic-assisted Secours had just begun. laparoscopy to enhance Recognizing that cancer traditional gynecologic rates run even higher in oncology procedures. Western Hampton Roads Gregory B. Franz, than other local and MD is a board certified national averages, Bon medical oncologist Christopher McCann, DO Secours invested another and hematologist. He $20 million to build the state-of-the-art Bon Secours Cancer attended medical school Institute at Harbour View in Suffolk, which began treating its at the University of first patients in late 2016. Rochester in Rochester, Offering innovative treatments like external beam radiation New York and completed therapy, advanced brachytherapy, mobile PET/CT and his internship at Gregory B. Franz, MD chemotherapy services, the Bon Secours Cancer Institute New York Hospital at Harbour View is focused on the mission of reducing death Queens (Cornell Medical School Program). After completing his rates for individuals with a diagnosis of cancer, and is on target internal medicine training, he went on to complete a fellowship in to provide more than 8,000 radiation therapy treatments for its hematology and medical oncology at the University of Tennessee patients each year. Health Sciences Center-National Comprehensive Cancer Network The Cancer Institute is located at Bon Secours Health Center at affiliated training site in Memphis, Tennessee. Harbour View, a premier outpatient destination serving Western Dr. Franz served as a director at a regional hospital-based Hampton Roads. The addition of the radiation therapy and oncology practice in Southeastern Georgia and as medical director infusion therapy services provides cancer patients with access to for a regional hospice program. Additionally, he has practiced diagnostic testing, outpatient surgery, and cancer specialists on the at a large Memphis hospital-based oncology practice, where he same campus. primarily focused on treating breast cancer patients and served as an Bon Secours is increasingly recognized as a leader in cancer investigator and participated in several clinical trials. More recently, treatment and innovation. A large part of that reputation is owed to he worked in private practice at the Piedmont Cancer Institute in its ability to attract physicians of the highest caliber, who come from Atlanta, Georgia. across the country to join the health system. Both the DePaul and Together with the multidisciplinary teams at the Bon Secours Harbour View Cancer Institutes have recently welcomed specialists. Cancer Institutes at DePaul and Harbour View, Dr. McCann and Dr. Christopher McCann, DO received his doctor of osteopathic Franz continue to elevate and expand cancer care and treatment to medicine degree from the University of New England. He the people of southeastern Virginia. Visit BonSecours.com for more completed his residency in obstetrics and gynecology at Saint information or to refer a patient.
Spring 2017 Hampton Roads Physician | 25
A Leap Forward in Diagnosing Prostate Cancer By Raman Unnikrishnan, MD
etecting prostate cancer can be notoriously difficult, as can deciding whether to treat or simply monitor confirmed or suspected malignancies. Thankfully, a new diagnostic technology called fusionguided biopsy is improving our ability to find the more aggressive cancers that do require early intervention. Unlike older screening tools, the UroNav Fusion Biopsy System offers detailed, real-time maps of the soft tissues of the prostate by combining MRI and ultrasound images. Our hope is to reduce unnecessary surgeries, repeated biopsies and other therapies that can cause troubling side effects like
erectile dysfunction, urinary incontinence and anxiety for patients who may have a slow-growing, non-lethal tumor – or no cancer at all. Before the 1980s, prostate cancer screening involved digital rectal exam alone, and the disease often went undetected until presenting in advanced stages. Since then, the prostate specific antigen blood test, or PSA, has caught significantly more cases, including many low-risk malignancies that may not need treatment. These tools have other significant diagnostic limits. Rectal exams only allow for access to part of the gland and may miss anterior tumors. As for the PSA, other medical conditions such as inflammation and benign Before the 1980s, prostate cancer screening involved prostatic hyperplasia can cause elevated levels digital rectal exam alone, and the disease often went of the same protein that increase with cancer. Ultrasound-guided biopsies require multiple undetected until presenting in advanced stages. needles to sample mapped out areas of the prostate in hopes that if a tumor is present, one of the needles will pierce it. MRI images are much more distinct, allowing radiologists to mark suspicious areas for further examination with an ultrasound probe. The “fusion” software overlays US and MRI images during the procedure, providing a Practice Opportunity for Full Time Provider live, three-dimensional view and critical guidance to direct biopsy Out Patient Opportunities needles to precise points. Fusion-guided biopsy can still miss tumors, but they tend to be the clinically insignificant ones – which is good news. The • Full time technology has 85 to 95 percent sensitivity for intermediate- and • New housing high-risk cancers that are more likely to metastasize and become opportunities life-threatening. readily available We currently are targeting fusion biopsy to two groups of men: patients with worrisome PSA levels who’ve previously had a • Lab and X-Ray on site negative biopsy who might otherwise have to go undergo another standard biopsy; and patients who are on active surveillance for • Competitive compensation prostate cancer for what we believe, but would like to confirm, are and beneﬁt package only low-risk tumors. This spreading technology is already a great leap forward in the quest to reduce hundreds of thousands of unnecessary interventions each year – and to catch the dangerous cancers that do matter to survival.
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Dr. Unnikrishnan is based at Urology of Virginia’s Portsmouth and Virginia Beach locations and is a member of the American Urological Association. He completed a residency in urology at the Cleveland Clinic and specializes in robotic-assisted and minimally invasive surgery, stone disease and benign and malignant conditions of the bladder, prostate and kidney. www.urologyofva.net
Boyd W. Haynes III, MD
revention of illness is an important part of our work with the patients we serve. Many of the mostly common and costly conditions that are seen today can often be prevented, such as adult onset diabetes, hypertension, obesity, heart disease, high cholesterol, etc. When we ask patients to eat a nutritious balanced diet, maintain a healthy weight and get sufficient aerobic and weight lifting exercise for their hypertension, heart health or diabetes, the same steps can be taken to avert common orthopaedic conditions, such as osteoarthritis (especially in the knees and hips) or osteoporosis. Recommending a healthful diet can help your patients’ bones and joints in many ways. A diet, such as the Mediterranean diet, rich in vegetables, olive oil, fresh seafood and low in sugar, has been shown to reduce systemic inflammation, which may aid in the prevention of OA. Calcium and vitamin D rich foods
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aid the body in keeping bones strong and dense, warding off osteoporosis. A multivitamin, tested by an independent lab for quality and purity, may also provide essential vitamins and minerals that may be missing but are necessary for good bone and joint health. I can’t put enough emphasis on the role that weightmanagement plays in helping prevent OA of the knees and hips. Healthy weight maintenance alone would help eliminate many of the joint replacements we must perform due to the wear and tear on joints caused by obesity. Losing weight is also a treatment for OA, and greatly relieves the associated pain and discomfort. Oddly, it is rarely mentioned to patients as a treatment outside of an orthopaedist’s office. Instead, physicians tend to recommend anti-inflammatory medications, physical therapy and even surgery, before weight loss. Exercise is also a very important part of any OA and osteoporosis prevention regimen. I have a saying that I often tell my patients: “Motion is life.” I truly believe that staying active and in motion can prevent or ease much of the pain, stiffness and inflammation caused by OA. I also know that staying active and fit reduces the chance patients have of injury when participating in sports or other activities. As a sports medicine specialist, I can attest to the difference in performance and resistance to injury my fit and active patients have compared to less fit, less active individuals. Weight bearing exercise and weight lifting, where the patient must work against gravity, are proven to help prevent osteoporosis or can assist the patient in rebuilding some of the bone density they may have lost. When bones are “stressed” against gravity, the resulting forces stimulate the bone to remodel. When the attached ligaments and tendons are stretched, this puts an additional strain on the bone, further intensifying this effect. Jumping and running are the best exercises for remodeling bone; however, benefits can be seen from any exercise that involves impact with the ground. Weight lifting enhances this effect and is recommended for maximum bone remodeling efficacy. Dr. Haynes is an orthopaedic surgeon and the Senior Partner at Orthopaedic & Spine Center in Newport News, VA. He is fellowship trained and Board certified in Sports Medicine and Orthopaedic Surgery. www.osc-ortho.com
28 | www.hrphysician.com
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FOR TOTAL HIP OR KNEE REPLACEMENTS, Think ‘Prehabilitation,’ Not Just Rehabilitation By Steve Howell, PT, M.Ed.
octors and nurses talk every day with patients about rehabilitation, and especially patients who need total hip or knee replacements because that is when the real work begins. It is general knowledge that physical therapy guides in the recovery process, but a comprehensive “prehabilitation,” program can be the key to a quick and full recovery.
Medical providers and patients alike are now beginning to understand the benefits of early intervention with preoperative physical therapy programs including: • One to two sessions for patient education in a home exercise program; • Gait training with a walker and cane, proper utilization of elevation and ice and pain control strategies; • Setting realistic post-surgical expectations for typical recovery periods and return to normal life activities; • Education in signs and symptoms of complications such as fever, severe pain, excessive drainage; • Faster recovery, less pain, and more confident patients who are compliant with exercise programs; • Less need for pain medications; • Decreased odds of readmission to the hospital. 30 | www.hrphysician.com
Beyond helping recovery, published studies have also focused on another key factor: cost reductions for patients. The APTA post sites an October 2014 study published in the Journal of Bone & Joint Surgery titled, “Associations Between Preoperative Physical Therapy and Post-Acute Care Utilization Patterns and Cost in Total Joint Replacement.” The study “looked at hip- and knee-replacement cases within a 39-county Medicare hospital referral cluster,” and concluded that “the use of preoperative physical therapy was associated with a 29 percent decrease in the use of any post-acute care services.” The APTA reports that “this translated, after adjusting for demographic variabilities and comorbidities, into cost reductions of $1,215—‘driven largely,’ the authors wrote, ‘by reduced payments for skilled nursing facility and home health agency care.’” The benefits of prehabilitation are seen in more than outpatient orthopaedic patients, too. Positive results have also been seen when implemented with cancer patients. The APTA post notes that in Nov. 2014, the Journal Anesthesiology published “Prehabilitation Versus Rehabilitation: A Randomized Control Trial in Patients Undergoing Colorectal Resection for Cancer.” Authors investigated “the impact of prehabilitation on recovery of functional exercise capacity was thus studied in patients undergoing colorectal resection for cancer.” Their conclusion: “Meaningful changes in postoperative functional exercise capacity can be achieved with a prehabilitation program,” add, “the preoperative period (prehabilitation) may represent a more appropriate time than the postoperative period to implement an intervention.” Prehabilitation programs are an excellent time to empower patients to commit to their return to health through exercise and education in the recovery process. These early visits with their physical therapist set the mental and physical tone for the coaching that is to come and their new productive lives. Steve Howell, PT, M.Ed. is a partner and practicing physical therapist with Pivot Physical Therapy, formerly Tidewater Physical Therapy. With almost 30 years of providing outpatient orthopedic care and a knee replacement in 2008, Steve knows the recovery process well.
RESPONDING TO REQUESTS FOR RECORDS AND/OR TESTIMONY …in the age of electronic information, some things a treating physician should consider By C. Thea Pitzen, Goodman Allen Donnelly
t some point in their careers, many physicians – especially It’s a wise old adage – made even more relevant in this new those who treat patients allegedly injured as the result age of electronic communication – that you shouldn’t put of another’s negligence – will be called upon to provide anything in writing that you wouldn’t want to see on the front copies of medical records, and possibly give testimony in a page of tomorrow’s newspaper. Today, that writing doesn’t have deposition or a court proceeding. to be on paper – it can exist as an email, a text, or anywhere on In this age of electronic charting and communications, there the Internet. are several things treating physicians should be cognizant of, chief When treating physicians are asked to give depositions – preamong them that such requests for records include not just the trial testimony – they should immediately seek out the risk chart itself, but also many electronic communications relating manager of their practice or hospital to discuss the matter. It’s to the patient. This can include emails, texts and transcripts also wise to consult an attorney, and when appropriate, to have or summaries of conversations as well, whether between the that attorney attend the deposition as well. It’s rare that anything physician and the patient or the physician and other consulting contentious arises in these instances, but an attorney can ensure providers. All of this material is discoverable, subject to pertinent the deposition proceeds in strict accordance to applicable rules. HIPAA considerations. Physicians should also be aware that in this age of electronic Thea Pitzen joined Goodman Allen Donnelly in 2016, and focuses record-keeping, electronic medical records (EMR) contain her practice on the defense of hospitals, physicians, dentists, nurses, substantial non-medical information; that is, metadata that shows nursing homes, and other health care providers. She is a graduate any time the record is accessed, any time the record is altered of Emory University School of Law, and previously served as judicial law clerk to U.S. District Judge William C. O’Kelley, Northern District of or changed in any fashion, and how many times the record has Georgia. www.goodmanallen.com been reviewed. Physicians should be aware that they might be questioned about why they accessed a certain record so frequently, as well as why and how it was edited. This metadata is stored and becomes part of the permanent medical record. It is, of course, important to maintain accurate and thorough medical records at the time of treatment. THANK YOU! The doctors and staff at Allergy & Asthma Specialists extend a More broadly, it’s important heartfelt thank you to all the physicians and staffs in Hampton Roads who to understand that social media refer their patients to us for allergy and asthma health care. We never lose sight of the fact that your referral is accompanied with a trust in us. is also subject to discovery. If a party maintains a Facebook page, Twitter account or other social media presence, to the extent that any posting is relevant to a case in litigation, that posting may have to be produced. For example, in the Dr. Gary Moss Dr. Greg Pendell Dr. Craig Koenig June Raehll Kim Pham Lisa Deafenbaugh interest of time, a physician might FNP-BC NP-C PA-C send a quick text or instant message to We make it as easy as possible on the patient and referring physician by ACCEPTING MOST INSURANCES. a colleague about a particular patient’s care. Such communications, however Virginia Beach (757) 481-4383 • Chesapeake (757) 547-7702 • Norfolk (757) 583-4382 brief, may be subject to production in www.allergydocs.net a subsequent legal matter. Spring 2017 Hampton Roads Physician | 31
How to Interview Lenders By J. Mansisidor
aking an informed decision about mortgage products relies on asking the right questions. The same holds true when selecting a loan officer. Some topics you may want to explore with prospective loan officers: Product Knowledge: How knowledgeable is the loan officer about “Doctor Loans” or “Medical Professional” loan programs? Does the loan officer specialize in working with medical professionals and really understand the unique circumstances that they face, or is the Doctor Loan just a product the loan officer has access to and sells as a novelty when circumstances fit? Experience: How long has the loan officer specialized in loans for medical professionals?
References: Does the loan officer have references available? Written testimonials are valuable when assessing how past clients feel about the loan officer. Attention to Detail: Does the loan officer take time to review your credit, research the area into which you’ll be moving, obtain accurate estimates for fees and insurance up-front, and then offer a quote that is truly customized to you? Relying on a quote that’s not based on accurate information is like trusting a diagnosis that’s not supported by lab work or imaging. Closings: Having your loan officer present doesn’t guarantee the closing will go smoothly, but it may be worth asking prospective loan officers how often they typically attend closings. Product Highlights: How well does each loan officer explain the relevance of loan products’ features to your situation? Does the loan officer seem to push the need for a down payment, or weigh the pros and cons of making a down payment? Availability and Communication: How easy was it to get in touch with the loan officer? How responsive was the loan officer? Can you reach the loan officer and get answers to questions after hours or on weekends? Differences You Notice: It’s a good idea to interview a few lenders – both to get an idea of the physician loan programs available and to get a sense for which loan officers seem most knowledgeable and willing to answer your questions.
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Be Vigilant: Notice what different loan officers mention and what they gloss over; if a particular point seems like it’s being overlooked or portrayed as unimportant, you may want to ask for additional explanation or greater specificity. Take note of the questions the loan officers ask you, and gauge for yourself whether they truly understand your situation and goals. The old adage caveat emptor – buyer beware – applies to the mortgage industry just like any other. Research your prospective loan officer: you can check the status of loan officers on line by looking up their NMLS numbers and verifying they are in good standing. You can use Google or other search engines to check on what customers have to say about loan officers. And, you can ask loan officers about the sites where they’re listed as preferred lenders. J. Mansisidor is a Senior Loan Officer with Fulton Mortgage Company a division of Fulton Bank, NA. www.fultonmortgagecompany.com
… the second in a series
n 2014, the National Institutes of Health noted, “Over the past 20 years, patient satisfaction surveys have gained increasing attention as meaningful and essential sources of information for identifying gaps and developing an effective action plan for quality improvement in healthcare organizations.” It’s become as much an economic imperative as a good will one: as reported in our last issue, “…payers are more and more tying a portion of reimbursement to patient satisfaction scores.” So how do patients measure their satisfaction? Certainly when they feel their concerns have been addressed, when they believe they’ve been listened to and heard – when they feel they’ve been understood. But how can a physician – with a standing-roomonly waiting room and a call-back list a yard long – get to really know and understand each patient? It can be something as complicated as reviewing Medicare records (see our Winter 2017 issue), or as minor as a simple ergonomic shift. “If you’re not ergonomically designed to prevent it,” says Dr. Anthony Bevilacqua of Sports Medicine and Orthopaedic Center, “you’ll end up looking at the computer when you should be looking at the patient.” He explains: “We had some room configuration issues in our old offices, and it could be very challenging to face our patients. When we moved, we bought computers on wheels, so we could look directly at the patient, rather than the computer screen.” That’s important, he says, because actually looking at patients provides so much information – “body language tells us a lot about the problem(s) they’re having, as much or more than they’re articulating.”
“To me,” Dr. Bevilacqua adds, “the treatment I prescribe has everything to do with who’s sitting in the chair. A patient thinks because his pain is similar to his friend’s, he’ll get the same treatment; people think medicine’s a cookbook thing: you come in with knee pain, so I prescribe X. But I’ve got 50 treatments for knee pain, and I have to figure out which one will work for the patient in the chair, whether or not his Dr. Anthony Bevilacqua symptoms mirror someone else’s. And now, with computers so omnipresent, if we’re focused on a screen, we can lose many of the vital visual cues we had before.” And, unfortunately, the necessity to populate the EMR can overtake the need to learn about the individual patient, he says, if everyone’s looking at the computer all the time. Dr. Bevilacqua resolves the issue by not touching the computer while he’s with patients. A tech sits across the room entering data, while he sits directly across from each patient, making eye contact, asking questions and taking notes. “I try to establish a personal connection with each patient,” he says, “and then I can add notes that will make that patient unique, which I can bring up at the next visit.” It takes longer to document the care he renders, Dr. Bevilacqua concedes, but it helps patients trust that he’s treating them, not their chart. And that kind of trust goes a long way toward building patient satisfaction. Spring 2017 Hampton Roads Physician | 33
Treating CHRONIC PAIN PATIENTS By Michael J. Ingraham, MD
hen most people hear the words “pain management,” they think of medications and procedures to fix existing problems. However, another important side to the field is preventive medicine – therapies that can guard against recurring pain or future injuries and improve overall health. As an Interventional Pain Medicine physician, a major goal is to help patients avoid long-term reliance on narcotics and invasive surgeries whenever possible. We often can ease discomfort and restore function and range of motion with therapeutic injections, in-office physical therapy, at-home exercises and stretches, and structured medication regimens. The bulk of our patients struggle with neck or lower back pain; some have suffered for years, if not decades. In many cases, nonsurgical interventions can provide months and sometimes years of relief without significant side effects, lengthy recovery times or risk of painkiller addiction. Once patients are feeling better and moving more, they also tend to improve on other important wellness indicators such as heart health, core strength and flexibility, mental outlook and sleep quality. Hampton Advertisement copy.pdf 1 3/23/2017 12:21:19 PM
For chronic pain patients who don’t respond to conservative therapies or in some cases surgery, or who aren’t surgical candidates, we can try two other procedures: radiofrequency ablation, or RFA, and a spinal cord stimulator, or SCS. RFA uses an electrical current to heat and destroy specific areas of nerve tissue, thereby reducing pain signals. The current is delivered via a small needle to a spot targeted by X-ray images, test blocks and patient feedback. The most common indications are neck, back or knee pain. The goal is at least six months of pain relief, but some patients feel better for as long as 18 months. The SCS, a technology similar to a pacemaker or defibrillator, is a battery-powered device placed under the skin in an outpatient surgery. The stimulator delivers mild electrical currents to nerve fibers in the back, creating a tingling sensation and interrupting pain signals to the brain. Patients can turn the current on, off or up with a handheld remote control. This relatively minor surgery can provide incredible pain relief. Before committing to any surgery, SCS patients first undergo a temporary trial to determine if a stimulator is a good option. Over a five-day period with trial leads – temporarily placed through hollow needles as an outpatient procedure with a local anesthetic – we can measure improvements in pain and the precise stimulation that was most effective. If a permanent SCS is implanted, “I strongly believe that the practice of law batteries last about seven years and can be is, at its core, a service profession. replaced easily. Delivering creative, thorough, and zealous With such a variety of treatment service and protection to our clients options, we are able to tackle complex guides my decisions and work product.” chronic pain issues and prevent continuing - Rodney S. Dillman health declines in more patients than ever. PARTNER WITH A RECOGNIZED Watching people return to overall wellness LEADER IN HEALTHCARE LAW. is extremely rewarding.
Dr. Ingraham is a fellowship trained Interventional Spine Specialist and Board certified Physical Medicine & Rehabilitation physician based at SMOC’s Suffolk and North Suffolk locations. He completed a fellowship in Pain Medicine at the University of Virginia School of Medicine. www.smoc-pt.com.
Hancock, Daniel, Johnson & Nagle, P.C. hdjn.com | 866.967.9604 |
34 | www.hrphysician.com
IN THE NEWS replacing large-incision abdominal surgeries with excellent outcomes. Bon Secours plans to use the system to perform a number of procedures including gynecological, colorectal, urologic, and general surgeries.
Bayview Physicians Group is pleased to announce that Coastal Surgical Specialists has joined Bayview, effective January 1, 2017. Coastal has been practicing in the Hampton Roads Community for more than 40 years. They now have five surgeons: Jeffrey J. Berger, MD; Beryl S. Brown, MD; Juan R. Gelpi, MD; Stephanie K. Repole, MD and Basil S. Skenderis, II, MD. Bon Secours Maryview Medical Center has added the da Vinci® Xi Surgical System to its surgical robotics capabilities. The system offers superior real-time visualization and greater dexterity and precision during minimally invasive robotics procedures. Its three-dimensional, high-definition vision system provides a highly magnified view inside the body and is optimal for complex, multi-quadrant surgeries, often
Caption left to right: June Hill, RN; Nora Paul, RN; Kelly Bailey, SA; Calvin Bailey, RN; Christopher McCann, MD; Charles “Pete” Williams, MD; Renee Morales, MD; Joseph Frenkel, MD; Rachel Lee, MD; Yassar Youssef, MD; Raman Unnikrishnan, MD; Brandon French, ST; Casie Cohan, RN; and Judy Brisson, RN.
Bon Secours Mary Immaculate Hospital has been designated a Magnet hospital by the American Nurses Credentialing Center (ANCC). Magnet designations recognize hospitals that achieve the gold standard for nursing excellence in the country. ANCC, a subsidiary of the American Nurses Association, is the world’s largest and most prestigious nurse credentialing organization. To qualify, hospital staff had to demonstrate excellence in specific quality indicators, such as low rates of hospital-acquired infections, patient falls and skin injuries, and high patient and nursing satisfaction. Four other Bon Secours Health System hospitals – and just nine percent of hospitals nationwide – have Magnet designation.
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IN THE NEWS
Bon Secours Hampton Roads was recognized by Inside Business, the Hampton Roads Business Journal, with the 2017 Health Care Hero award in The Advancements in Community Health category for its proactive approach to health risks such as chronic conditions and poor nutrition, which are tackled through a variety of programs, partnerships and screening events.
36 | www.hrphysician.com
Chesapeake Regional Healthcareâ€™s Cancer Treatment Center has installed a Sentient Radiation Therapy Suite that allows patients to create a unique, individualized experience during each treatment session. The innovative suite offers ambient lighting in a variety of colors and more than 19 nature videos and themes for patients to choose from, based on their favorite color, movie or music genre. During radiation procedures, patients can watch custom videos on a large monitor placed on the ceiling just above the treatment area and enjoy audio options such as nature sounds, streaming music or their own play lists.
Children’s Hospital of The King’s Daughters, along with University of Virginia Children’s Hospital, has appointed Dr. James Gangemi as surgical director of the new regional collaborative for cardiac care at CHKD. The UVA/CHKD partnership combines the efforts of pediatric cardiologists, cardiac surgeons, cardiac anesthesiologists, intensive care physicians and cardiac support professionals from both institutions with the goal of improving outcomes for children with complex congenital heart defects. Dr. Gangemi, also surgical director of congenital heart surgery at UVA Children’s Hospital, facilitates weekly conferences with team members and will perform pediatric heart surgeries at CHKD at least four days each month.
Chesapeake Regional Healthcare has initiated the use of four state-of-the-art Tru-D Smart UVC robots, part of the hospital’s commitment to provide a clean and safe environment for patients. The ultraviolet light technology allows hospital staff to easily disinfect virtually any environment, including patient rooms, intensive care units, operating rooms, emergency rooms and public areas. The 28-bulb UV disinfection robots have been clinically proven to destroy more than 99.9 percent of germs on surfaces, killing deadly pathogens and common bacteria that can compromise the health of patients. Children’s Hospital of The King’s Daughters is proud to introduce EOS imaging technology to the region. This groundbreaking X-ray system uses an ultra-low dose of radiation to capture detailed skeletal images with a single scan. The three-dimensional, full-body images of patients in a standing position are ideal for analyzing balance, posture and bones, joints and ligaments for diagnosis and treatment of many musculoskeletal conditions involving the spine, hip and legs. Low radiation and fewer scans are especially important with conditions such as scoliosis that require frequent X-rays. CHKD offers EOS imaging at locations in Chesapeake and Newport News.
Children’s Hospital of The King’s Daughters raised a record $205,000 at its seventh annual Vegas-style charity event, again hosted by hometown hero and New York Mets captain David Wright. Nearly 400 hospital supporters attended the Jan. 20 event at the Virginia Beach Convention Center, enjoying a poker tournament and casino games, cocktails and appetizers, dancing and auction items.
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Spring 2017 Hampton Roads Physician | 37
IN THE NEWS ABS Technology was this year’s title sponsor. The event’s seven-year cumulative total has topped $1.1 million, providing critical support for patient care.
The College of William and Mary raised more than $40,000 for Children’s Hospital of The King’s Daughters at its third TribeTHON, a Children’s Miracle Network Hospitals® Dance Marathon organized by students. Participants, including William and Mary students, CHKD patients and hospital supporters, danced from 2 pm to midnight on Feb. 11th. Miracle Network Dance Marathon is a nationwide movement involving college and high school students at more than 300 schools across the country, all raising money for hospitals in their communities.
David Darrow, MD, DDS, Professor of Otolaryngology-Head and Neck Surgery at Eastern Virginia Medical School, was elected President of the Society for Ear, Nose and Throat Advances for Children (SENTAC) at its recent annual meeting in Orlando. SENTAC is a nonprofit, service-oriented society founded in 1973 that is devoted to research and advancement of the treatment of ear, nose and throat maladies in children. Dr. Darrow also served for 13 years on the executive committee of the American Academy of Pediatrics’ Section on Otolaryngology-Head and Neck Surgery, including terms as its Chair and Program Chair. Dr. Paul Marik, MBBCh, a critical-care physician at Eastern Virginia Medical School, has developed what he believes could be a cure for sepsis. While caring for patients in the general intensive care unit at Sentara Norfolk General Hospital, Dr. Marik – the EVMS Foundation Distinguished Professor in Internal Medicine and Chief of Pulmonary and Critical Care Medicine – created a formula of three common compounds given intravenously: vitamin C, steroids and thiamine. According to a retrospective study, there were no deaths among 47 patients diagnosed with sepsis who received the new treatment.
MEDICAL PROFESSIONALS PROGRAM For over 14 years, J. Mansisidor has been working with doctors on their lending needs. We offer programs dedicated to making home ownership easy and affordable.
• A program designed for medical professionals* including MD, DO, DDS, DMD, PHARMD and VMD • 15 & 30-Year Fixed Rates** as well as Adjustable Rate Options Available
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38 | www.hrphysician.com
Fulton Bank, N.A. is a Member FDIC. Member of the Fulton Financial Family. Subject to credit approval. *Medical Doctorate degree required. Restrictions apply. **Monthly payment for a $250,000 15-year term mortgage at 3.582% Annual Percentage Rate (APR) would be $1,787.21. Monthly payment for a $250,000 30-year term mortgage at 4.414% APR would be $1,248.21.
The New Hope Center for Reproductive Medicine marked its 20th birthday on Monday, February 27, celebrating two decades of helping families in Hampton Roads. In addition, the practice was named a 2017 Small Business Center of Excellence by Best Businesses.
Farm Fresh Food & Pharmacy has again helped local children battling cancer with its 17th annual Round Up campaign, which encourages customers to contribute to Children’s Hospital of The King’s Daughters by rounding-up their grocery bill to the nearest dollar, or by making an additional donation. In 2016, Farm Fresh’s campaign raised $179,874 to CHKD’s cancer program; over the last 16 years, the grocer has raised more than $8.1 million. Hampton Roads Orthopaedics & Sports Medicine is happy to welcome Dr. Michael Cook, a Board certified chiropractic physician and acupuncturist, to its Interventional Pain Management clinic in Newport News. To provide patients with even more treatment options, HROSM has integrated spinal manipulation, acupuncture and laser therapy into its extensive pain management paradigm. These conservative therapies can help resolve many common concerns, including mechanical back, neck and shoulder pain, fibromyalgia, muscle injuries, arthritis and headaches.
Robin Poe-Zeigler, MD
Are You an Independent Physician ?
Medical Practice Specialists
The Hampton University Proton Therapy institute (HUPTI) has partnered with the VA Hospitals in Hampton Roads to educate men and women in our armed services about the benefits of Proton Therapy cancer treatment. This outreach initiative will provide veterans and active duty military personnel with information to increase their awareness of potentially life-saving cancer treatment options, such as proton therapy, while granting them exposure to the HUPTI facility through on-site tours and educational seminars. The process will conclude with consultations and treatment for affected veterans in the region. Integrated Dermatology of Tidewater has acquired the dermatology practices of Dr. Arnold Oppenheim and Dr. William Shields, following their recent retirements. Dr. Oppenheim’s former office is now closed, and all patients are being seen in the Norfolk office. Dr. Shields’ practice in Newport News has been renamed Integrated Dermatology of Newport News; Dr. Jonathan Schreiber and his assistant, Amanda Hullett PA-C, along with Dr. Shields’ staff, are available to see patients.
John G Corley III MBA, CPBC John@mmcgonline.com
Christopher L Graff JD, CPBC Chris@mmcgonline.com
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Spring 2017 Hampton Roads Physician | 39
IN THE NEWS Dr. Constance Okeke, a glaucoma specialist with Virginia Eye Consultants and faculty member at Eastern Virginia Medical School, has published a new book that shares her seven years of clinical experience with using Trabectome surgery, a minimally invasive procedure to lower eye pressure. The Building Blocks of Trabectome Surgery, Volume 1 – Patient Selection aims to help both beginning and experienced eye specialists better understand the micro-incision surgical option and how it can apply to glaucoma patients. Andrew Plunk, PhD, MPH, Assistant Professor of Pediatrics at Eastern Virginia Medical School and a researcher in the Community Health and Research division of EVMS Pediatrics, has received a federal grant to study the issue of smoking in public housing developments. The three-year, $504,592 grant from the Healthy Homes Technical Studies Program of the Department of Housing and Urban Development, will fund research led by Dr. Plunk and Paul Harrell, PhD, Assistant Professor of Pediatrics, into the health impacts of a new HUD rule that will require smoke-free housing by August 2018. Riverside Health System has launched the first phase of a complete transformation of its electronic health record platform. The new iCare EHR system was implemented throughout Riverside Medical Group practices on March 1. Riverside will launch iCare throughout the remainder of the system in June of this year. This conversion is the largest technology overhaul of clinical and business practices in Riverside’s history. Riverside has long been a pioneer of electronic health records, starting in 1996 when less than one percent of physicians had EHRs.
Riverside Regional Medical Center placed the last beam in March for its Pavilion tower expansion. The $67 million project to add two floors to the Pavilion tower began in August and is expected to finish in late 2018. The construction will add about 150,000 square feet, but no new beds outside of what is licensed. Riverside also is converting 144 beds to private patient rooms. CORRECTION An announcement in the Winter edition was worded incorrectly. The item should have read: Dr. Wilford Gibson performed Hampton Roads’ first MAKO guided outpatient anterior hip replacement procedure in September 2016 at Chesapeake Regional Healthcare. We apologize for the error. 40 | www.hrphysician.com
Rite Aid is raising funds for Children’s Hospital of The King’s Daughters through May 6 at all of its 77 stores in Hampton Roads. Customers who buy a $1 paper Miracle Balloon will receive $7 in coupon offers, good for a variety of popular products sold at the drug store. Over the past 22 years, Rite Aid has raised more than $850,000 for the children at CHKD. Their support helps purchase equipment, fund research and provide patient care programs. Virginia Eye Consultants is accepting nominations for its fourth annual Looking Forward…Giving Back program, which provides free eye procedures for Hampton Roads residents who are uninsured, underinsured or financially unable to pay for treatment. These sightsaving procedures can include cataract surgery, LASIK surgery, corneal transplants, glaucoma surgery and treatments for trauma. Nominations will be accepted through Monday, May 15 and can be made online or at any of the practice’s five locations. A panel will review and select nominees in late May; surgeries will be performed in August.
WomanCare Centers, PLC has received a March of Dimes community grant funded by Anthem Blue Cross and Blue Shield Foundation to continue the CenteringPregnancy program. CenteringPregnancy is a team approach to care that actively engages patients in goal setting, skill-building, and peer support, with provider-facilitated group health care that allows more time to explore important health topics. The model includes three components of care: assessment, learning, and community building. The goal is to enhance prenatal education and empower mothers to have healthy, full-term babies.
WELCOME TO THE COMMUNITY
Howis Aros, MD has joined Sentara Hospital Medicine Physicians at Sentara Norfolk General Hospital. Dr. Aros earned her medical degree from University of Kansas School of Medicine and completed her residency at Research Medical Center. She manages the day-to-day care of patients while they are in the hospital.
Nicholas Galardi, MD has joined MageeRosenblum Plastic Surgery in Norfolk, Virginia Beach and Chesapeake. Dr. Galardi earned his medical degree at the West Virginia University School of Medicine. He completed his Plastic Surgery residency at University of Miami and his General Surgery residency at Eastern Virginia Medical School.
Leo Bowers, MD has joined Sentara Hospital Medicine Physicians at Sentara CarePlex Hospital. He earned his medical degree from Medical College of Virginia and completed his residency at St. Elizabeth Medical Center. Dr. Bowers works with all specialists and care team members involved to develop a comprehensive and individualized treatment plan for each patient.
Radha K.C., MD has joined Sentara Internal Medicine Physicians in Norfolk. She earned her medical degree from The Institute of Medicine at the Maharajgung Central Campus and completed her residency at St. John’s Episcopal Hospital. Dr. K.C. specializes in the prevention and treatment of minor and complex conditions for adults 18 years of age and older.
Elizabeth Chiang, MD has joined Southside Eye Care. Dr. Chang is a comprehensive ophthalmologist and is fellowship trained in oculoplastic reconstructive surgery. She earned her medical degree and a PhD in Neuroscience from Case Western Reserve in Ohio, attended an Ophthalmology residency at Northwestern University and completed her fellowship training at the Medical College of Wisconsin, Milwaukee.
Paul King, MD has joined Sentara Hospital Medicine Physicians at Sentara Leigh Hospital. Dr. King earned his medical degree and completed his residency at Eastern Virginia Medical School. He collaborates with other specialists involved to provide his patients a comprehensive treatment plan.
Specializing in: • Physical Therapy • Voiding Dysfunction
We proudly offer Comprehensive Urologic Care serving Portsmouth, Western Branch and North Suffolk Communities. Our physicians and physical therapists offer comprehensive evaluation, surgical and non-surgical treatments options and will help you choose the appropriate treatment plan. Nathan Goldin, MD, FACS—Has served the Portsmouth Community for over 30 years Akin Ojo-Carons, MD-Fellowship Trained in Female Pelvic Medicine Raman Unnikrishnan, MD—Trained in Robotic/Minimally Invasive Surgery at the esteemed Cleveland Clinic Erin Glace, MSPT, PRPC, BCB-PMD
• Pelvic Organ Prolapse • Urinary Incontinence • Overactive Bladder for Men and Women • Neuro-urology • Pelvic Pain/Chronic Prostatitis • Kidney/Ureteral Stones • No Scalpel Vasectomy • Minimally Invasive Surgery • Bladder, Kidney & Prostate Cancer • General Urology
Christie Lee Icenhour, PT, DPT
3640 High St, Suite 3B Portsmouth, VA 23707
Nathan Goldin, MD, FACS
Akin Ojo-Carons, MD
42 | www.hrphysician.com
Erin Glace, MSPT, PRPC, BCB-PMD
Christie Lee Icenhour, PT, DPT
Nicole Kreiser, PhD has joined EVMS Psychiatry & Behavior Medicine. Dr. Kreiser completed her Postdoctoral Residency at Virginia Tech in Clinical Child Psychology/Neurodevelopmental Disabilities, where she provided comprehensive assessments and therapy for toddlers, children and adolescents with suspected or diagnosed Autism Spectrum Disorders (ASD). She completed an internship at the University of Colorado, Denver Department of Family Medicine in Developmental Disabilities; and Resident Training at the Kennedy Krieger Institute, Department of Neuropsychology. Stephen Langston, MD, FACS has joined Sentara Surgery Specialists at Sentara Obici Hospital. An experienced general surgeon, Dr. Langston earned his medical degree from University of Alabama School of Medicine and completed his residency at Atlanta Medical Center. He takes advantage of the latest innovations, minimally invasive procedures and state-of-the-art technology for patient care. Danya Lewis, MD has joined EVMS Psychiatry & Behavior Medicine. Dr. Lewis received her medical degree from Albany Medical College in Albany, NY, and completed her psychiatry residency at Eastern Virginia Medical School. Dr. Lewis is Board certified by the American Board of Psychiatry and Neurology. Her clinical interests
include general adult psychiatry, medication management and treatment, women’s health, mood and anxiety disorders, and veteran’s mental health. George Sarris, MD, FACC, FASE has joined Sentara Cardiology Specialists in Suffolk. Dr. Sarris earned his medical degree from Mount Sinai School of Medicine. He completed his fellowship at Washington University School of Medicine and his residency at Barnes-Jewish Hospital. He is an experienced cardiologist and is highly trained to evaluate and treat diseases of the cardiovascular system, including the heart, arteries and veins. Kimberly Schlesinger, MD has joined Riverside Tappahannock Cancer Institute. Dr. Schlesinger earned her medical degree from the University of Pittsburgh School of Medicine. She completed an internal medicine residency at the University of Virginia Health Sciences Center, and took fellowship training in hematology and medical oncology at the University of Pittsburgh School of Medicine. Dr. Schlesinger is Board certified by the American Board of Internal Medicine with additional certification in medical oncology and hematology.
More than 40 million Americans suffer from chronic sleep disorders every night. Many don’t even know it.
Whoever Said Counting Sheep Helps You Sleep
Should Be Put Out To Pasture. CRH-011-16-sheepad_final.indd 1
You know a good night’s sleep is essential to good health. If your patients aren’t sleeping well at night, send them to Chesapeake Regional Healthcare for a sleep study. We’ll handle the rest. • The Sleep Centers at Chesapeake Regional Healthcare are fully accredited by the American Academy of Sleep Medicine. • We also have all of the necessary equipment for pediatric sleep studies and provide accommodations for parents to stay the night with their child. • For your convenience, appointments can be made in Chesapeake or at our Elizabeth City Sleep Center.
800 Battlefield Boulevard, North Chesapeake, VA 23320 • 757-312-6565 chesapeakeregional.com/sleep
1/15/16 | 9:49 Spring 2017 Hampton Roads Physician 43AM
WELCOME TO THE COMMUNITY
Kimberly Span, MD has joined Sentara Hospital Medicine Physicians at Sentara Virginia Beach General Hospital. Dr. Span earned her medical degree and completed her residency at Eastern Virginia Medical School. She collaborates with other specialists involved to provide her patients a comprehensive treatment plan.
Michelle C. Walters, MD has joined Associates in Dermatology, Inc. Dr. Walters, a Board certified dermatologist, earned her medical degree from Georgetown University.Â She served in the US Navy and completed a transitional internship at the Naval Medical Center in San Diego, CA, before serving as the General Medical Officer aboard the aircraft carrier USS Nimitz (CVN-68). Dr. Walters is a Fellow of the American Academy of Dermatology and a member of the Association of Military Dermatology and the Womenâ€™s Dermatologic Society.
Welcome NPs and PAs
Lishia Barnes, NP Sentara Neurology Specialists, Norfolk
Christina Cournoyer, NP Sentara Family Medicine Physicians, Hampton
Jessica Cournoyer, NP Sentara Family Medicine Physicians, Western Tidewater
Robert Dearnley, PA Sentara Urgent Care, Newport News
Moniqueia Flint, NP Sentara Family Medicine Physicians
Julie Flores, NP Sentara Vascular Specialists, Suffolk
Patty Hannah, NP Sentara Vascular Specialists, Hampton
Cindee Hawkins, PA-C Internists of Western Branch
Caitlin Johnson, MSN, FNP-C Bayview Physicians Group
Tracy Land, NP Sentara Pulmonary, Critical Care & Sleep Specialists
Rebecca Leuzzi, FNP-C Bayview Physicians Group
Laura Marcinczyk, NP Sentara Neurology Specialists care team
Anastasia Nelson, PA Sentara Urgent Care, Virginia Beach
Yasmin Nuru, NP Sentara Family & Internal Medicine Physicians, Williamsburg
Maria Picardo, NP Sentara Hospital Medicine Physicians at Sentara Leigh Hospital
Rebecca Samples, NP Sentara Vascular Specialists, Norfolk
Meghan Theis, PA Sentara Urgent Care, Williamsburg
Hali Thomas, NP Sentara Neurology Specialists, Norfolk
Debra Vaccaro, NP Sentara Internal Medicine Physicians, Williamsburg
Mary Gates Walter, NP Sentara Pratt Medical Group
Jenny Whittington, PA Sentara Urgent Care, Virginia Beach
Jessica Willis, MSN, FNP-BC Peninsula Kidney Associates
Shuhua Yin, NP Sentara Family Medicine Physicians, Elizabeth City
44 | www.hrphysician.com
B O A R D A D V I S O R Y P H Y S I C I A N
2017 ADVISORY BOARD
Anthony T. Carter, MD, FAAOS
Steven Pearman, MD
Orthopaedic Surgeon Board certified orthopaedic surgeon with Hampton Roads Orthopaedics & Sports Medicine. Dr. Carter specializes in minimally invasive joint replacement surgery of the hip and knee.
Family Medicine As a Board certified family medicine physician, Dr. Pearman practices at Sentara Family Medicine Physicians in Virginia Beach and also serves as Vice President & Senior Medical Director of Primary Care & Ambulatory Services of Sentara Medical Group.
Jessica DeLong, MD
Robin Poe-Zeigler, MD, FACOG
Reconstructive Urology Dr. DeLong practices in Virginia Beach at the Devine-Jordan Center for Reconstructive Surgery and Pelvic Health, a Division of Urology of Virginia. She is Board certified in Urology and Fellowship trained in Adult and Pediatric Reconstructive Urology.
Reproductive Endocrinology and Infertility Practicing REI physician in Hampton Roads since 1993 and has owned her own practice since 1997. Currently serves as the Medical Director at the New Hope Center for Reproductive Medicine.
Susan B. Girois, MD, MPH, FACP
Merfake Semret, MD
Primary Care Board certified in Internal Medicine in practice in Hampton Roads for five years. Currently serves as Chief Medical Officer for JenCare Senior Medical Centers in Tidewater.
Nephrology Dr. Semret is a Board certified internist and nephrologist. Practices nephrology with Peninsula Kidney Associates in our Hampton, Newport News and Williamsburg offices. He also serves as the medical director at Davita Langley dialysis unit.
David Goss, MD
Barry Strasnick, MD
Orthopaedic Spine Surgery Dr. Goss practices at The Spine Center at Chesapeake, a Division of Sports Medicine and Orthopaedic Center. He is Board certified in Orthopaedic Surgery and Fellowship trained in Spinal Surgery.
Otolaryngology Board certified in Otolaryngology: Neurotology. Dr. Strasnick is Chair of EVMS Otolaryngology-Head & Neck Surgery, a physician leader in his specialty and past Medical Director of EVMS Medical Group
Robert R. Harding, MD
Raj N. Sureja, MD
Internal Medicine Board certified in Internal Medicine. He practices as a hospitalist at Riverside Doctorsâ€™ Hospital Williamsburg and serves as Chair of the Riverside Medical Group Board.
Pain Management Board certified and Fellowship-Trained Interventional Pain Management Physician, in practice since 2008. Senior Pain Management Partner at Orthopaedic & Spine Center in Newport News, VA.
Lauren James, MD
Richard Wertheimer, MD
Family Medicine Dr. James is the Lead Physician at Portsmouth Medical Associates of Bon Secours Maryview Medical Center. She is Board certified in Family Medicine.
Neurologist Dr. Wertheimer practices at Neurological Associates of Hampton Roads, Chesapeake Regional Medical Group. He is Board certified in neurology and electrodiagnosis, and fellowship trained in neuromuscular disease.
Spring 2017 Hampton Roads Physician | 45
Celebrating the Accomplishments of Physicians Who have Received Major Honors
Alfred Abuhamad, MD, the Mason C. Andrews Chair in Obstetrics and Gynecology, Professor and Chair of Obstetrics and Gynecology, and Vice Dean for Clinical Affairs at Eastern Virginia Medical School, was recently named President of the Society for Maternal Fetal Medicine (SMFM). SMFM is a society of physicians and scientists who are dedicated to the optimization of pregnancy and perinatal outcomes. Dr. Abuhamad has served on the governing board for the past 10 years as a member of the Board of Directors and the Executive Committee.
Rebecca Britt, MD was elected 1st Vice President of the Southeastern Surgical Congress at the recent meeting in Nashville, TN. The Southeastern Surgical Congress is a premier regional surgical organization for general surgeons and surgical subspecialists, with more than 1000 active members. Dr. Britt is the second woman to serve in this role.
Robert Lancey, MD, MBA, medical director of the Bon Secours Heart & Vascular Institute, was honored with the Health Care Heroes award from Inside Business, the Hampton Roads Business Journal, and was recognized for developing the Heart Health Academy at Bon Secours, an innovative initiative that educates middle school students about the importance of making heart-healthy decisions early in life.
David M. Pariser, MD of Pariser Dermatology Specialists was awarded the Gold Medal from the American Academy of Dermatology (AAD) at its annual meeting in March. The Gold Medal is the highest award available in the AAD and is presented in recognition of exceptional service to the practice of dermatology. A practicing dermatologist for more than 40 years, Dr. Pariser is a world-renowned expert on atopic dermatitis, psoriasis, hyperhidrosis and photodynamic therapy. He has been involved in clinical research trials on many of the drugs now commonly used in dermatology; he also has lectured and taught doctors around the world.
Bradley Prestidge, MD, MS, medical director of radiation oncology and radiation oncologist with Bon Secours Oncology Specialists, has been selected as an inaugural Fellow of the American Brachytherapy Society. Dr. Prestidge is one of only 12 physicians nationwide to receive this honor, which recognizes contributions to the field of brachytherapy. The ABS, a nonprofit organization, provides education and research on the highly-targeted form of radiation, delivered through small implanted seeds or devices to treat malignant and benign conditions. Dr. Prestidge, a world-renowned radiation oncologist with 27-plus years of experience, offers brachytherapy for many types of cancers, including prostate, breast, cervix and skin. 46 | www.hrphysician.com
Managing Pain You Can’t See
“When the imaging doesn’t show us abnormalities, we have to treat the patient and what they say. It’s so important to listen, both to how the patients describes the pain and what they’ve already tried to control it.” Dr. Victor Tseng, Interventional Pain Medicine Specialist
One of the best reasons to see an interventional pain medicine specialist is that they are well trained in the latest methods for managing pain. They understand how the body is put together to find the source of your pain and up-to-date on the latest research.
CALL US TODAY TO SCHEDULE AN APPOINTMENT Pictured above (L-R): Michael Ingraham, MD; Scott Clingan, MSHS, PA-C; Victor Tseng, DO
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757-547-5145 | smoc-pt.com Chesapeake | Suffolk | North Suffolk
DEPAUL MEDICAL CENTER
UNRIVALED STROKE CARE When someone suffers a stroke, time really matters. Thatâ€™s why Bon Secours DePaul Medical Center has assembled a multidisciplinary team of neurologists, neurointerventionalists, radiologists and nurses to deliver the highest quality of care, even for the most complex cases. Our facility features a state-of-the-art neuroendovascular lab and dedicated neuro intensive care unit. Our fully accredited comprehensive stroke center is unrivaled in providing the most advanced technology and interventional treatment options.
To learn more, visit BonSecours.com or call 757-889-2273.
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